PokitDok Launches Digital Eligibility and Pricing Estimate Services for Prescription Medications

New Suite of Pharmacy APIs Brings Quick Data Access Prior to Writing Prescriptions and Sending Patients to Pick Them Up

In its mission to power the business of healthcare, PokitDok introduced a suite of Pharmacy Benefit and Eligibility tools during the American Telemedicine Association Annual Conference earlier this week. Through three new Application Programming Interfaces (API), PokitDok now gives physicians, EMRs and other digital health innovators a consolidated view of patient prescription plans, qualified formularies, in-network pharmacies, and related financial information. This level of real-time digital access provides insight into which medications are covered by a member’s insurance plan before prescribing, ensures those drugs are available for pick up from a qualified pharmacy, and subsequent payment is processed accurately. The APIs can enhance a medical visit by enabling more informed treatment plans, whether it takes place at a hospital, private practice or through a telemedicine session from the comfort of home.

“Today, much of the critical financial and administrative components of picking up a prescription are addressed after the fact,” said Lisa Maki, co-founder and CEO, PokitDok. “Like most ways we make a purchase, it should start with knowledge of what you’re buying, potential risks and price implications. How much is this prescription going to cost me? Is it covered by my insurance? Are there equally effective but cheaper options? Where do I pick it up or does it have to be shipped to my house? The technology is finally here to reverse that problematic workflow and inspire more intelligent medication decisions.”

To date, more than 4000 applications have been built on PokitDok’s development platform. The new set of APIs are immediately available and developers can integrate them into existing health IT systems today. They include:

1. Pharmacy Plan API, which reveals a member’s pharmacy plan name, premium, deductible, initial coverage limit and copays for each tier – from lower cost generic drugs to patented medications. Plans can vary in their drug coverage and prices for the same drug are not always the same. PokitDok makes information available from more than 16 million Medicare Advantage Beneficiaries and 40.5 million who rely on Medicare Part D Prescription Drug Benefit Plans. Private health insurance plans separate from Medicare are under development.

2. Pharmacy Formulary API provides a deep dive into the member’s pharmacy benefit, including what drugs a patient is eligible for and how much they can obtain at one time. It covers tier level, authorization and step therapy requirements, which require patients to try one drug before progressing to a drug that may introduce health risks or an additional expense, and quantity limits. This API covers the economic components, including an estimated price and cost break down of who is paying what. It returns details about a medication’s out of pocket cost, total cost, and payment that insurance kicks in.

3. In-Network Pharmacy API geolocates retail pharmacies, identifies available mail order institutions and authenticates the dispensing pharmacy as being covered by insurance, giving patients an informed choice for prescription fulfillment. The National Provider Identifier (NPI) is used to verify the prescribing party, such as a physician, nurse practitioner, physical therapist or dentist. PokitDok makes this information available from one of the largest provider directories on the market.

While hospitals and medical practices maintain electronic health record systems (EHRs) to house patient health history, the prescription benefits process may not be optimally integrated. Electronic prescribing relies on technology developed more than a decade ago, which still requires batch file transfers of volumes of data. This lack of real-time integration induces an inefficient review process and is difficult to navigate. As a result, in many cases, eligibility, coverage and cost is not considered before writing a prescription. For the first time ever, PokitDok makes a library of drug information, formularies, Medicare Part D pharmacy network and pricing information available through an API that draws data from the Centers for Medicare & Medicaid Services (CMS) and First Databank.

“Right now, there are too many draconian steps in the pharmacy management process, which layers in costs and mistakes that often contribute to a less than ideal experience-of-care for patients and members,” said John Moore, founder and managing partner, Chilmark Research. “PokitDok is introducing a modern way to make critical data available in a format that’s simple to read and based on the business need, rather than building rigid enterprise software that forces a generic process on the customer.”

For more information or to access the PokitDok development platform, go to https://platform.pokitdok.com.